title: [Clinical application of a fully covered self-expandable metallic stent in treatment of airway fistula].
abstract: OBJECTIVE
  To assess the feasibility, safety and efficacy of the use of a fully covered self-expandable stent for the treatment of airway fistula.
  
  
  METHODS
  From August 2005 to November 2011, 9 patients underwent treatment by the introduction of a tracheo-bronchial or bronchial fully covered self-expandable metallic stent. There were 7 males and 2 females, aged from 28-65 years with a mean of 46 years. In this group, 7 cases were diagnosed as bronchopleural fistula, 1 case as tracheopleural fistula, 1 case as broncho-esophageal fistula, 8 cases with thoracic empyema. The fistula orifices were from 3.5-25.0 mm in diameter with a mean 8.4 mm. All patients received topical anesthesia, and L-shaped stent was placed in 6 patients and I-shaped stent in 3 patients under fluoroscopic guidance. After the stent placement, the patients with empyema were treated with continual irrigation of the empyema cavity.
  
  
  RESULTS
  Stent placement in the tracheo-bronchial tree was technically successful in all patients, without procedure-related complications. The operating time was from 5-16 minutes, mean time (10 ± 4) minutes. Except for 1 patient, immediate closure of the airway fistula was achieved in the other patients after the procedure, as shown by the immediate cessation of bubbling in the chest drain system or the contrast examination. In this study, 1 patient coughed the inserted stent out due to irritable cough on the 5th day and had to receive repositioning of a new stent. Among the patients who were with empyema, 1 patient died of septicemia on the 8th day and 1 patient died of brain metastases from lung cancer 6 months after the stent insertion with empyema not cured, the other 6 patients' empyema healed from 2-5 months, mean time 3.7 months. Seven patients were followed from 3 to 36 months with a median of 13.5 months. During follow-up, 1 stent was removed from a patient 8 months after the stent implantation without empyema recurred. The remaining patient presented good tolerability to the existence of stent. The stents remained stable, no migration occurred, no empyema recurred, and the patient with broncho-esophageal fistula fed and drunk well.
  
  
  CONCLUSIONS
  The use of fully covered self-expandable stents proved to be a safe, effective and fast minimally invasive method to treat airway fistula, especially for patients with a higher surgical risk or other failed treatments.
authors.affiliation: Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zang
authors.forename: Zhong-min
authors.initials: ZM
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Ming
authors.initials: M
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D008670:Metals